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Thursday 11 January 2018 Members Forum MATTERS FOR DECISION
1. Agenda Items Led by Welcome Clare Highton MEMBERS’ FORUM 2. Members’ Forum Matthew Knell CLINICAL COMMISSIONING FORUM 3. Primary Care Update: CCE Contract Mark Rickets 4. Data Sharing with Social Care Anita Ghosh 5. AOB
Items for discussion and decision 1. Ratification of appointment of Christopher Gallagher as Secondary Care Consultant for the NHS City & Hackney Clinical Commissioning Group (CCG) Governing Body (GB); 2. Consideration of changes to the CCG’s Constitution to remove term limits for the GB Nurse and Secondary Care Consultant; 3. If term limits are agreed to be removed for the GB Nurse and Secondary Care Consultant, that Siobhan Clarke is appointed to serve a new two term as GB Nurse from 1 April 2018.
Secondary Care Consultant Background and Recommendation • • • Our current GB Secondary Care Consultant, Christine Blanshard comes to the end of her term on 31/03/2018. We started the recruitment process to appoint a new post holder in November 2017; Christopher Gallagher was successfully interviewed for the Secondary Care Consultant role on the CCGs GB on Wednesday 20 December 2017 following an open application process. He was the only eligible candidate to apply for the role; The CCG had to extend the application period twice for this role to secure a suitable application – even with extensive advertisement and use of networks to secure potential candidates; Both the GB Consultant and Nurse roles have nationally set restrictions on eligibility that has limited the pool of potential candidates – we cannot appoint anyone who works for a provider with which we hold a contract. This rules out the majority of clinicians working in London; A short biography of Chris will be available at the Members Forum meeting; RECOMMENDATION: The Members Forum is asked to ratify Chris’s appointment to the CCGs Governing Body as our Secondary Care Consultant for a first term of two years.
CCG GB Nurse recruitment Background and recommendation • Our current GB Nurse, Siobhan Clarke comes to the end of her term on 31/03/2018. We started the recruitment process to find a new post holder in November 2017; • Despite extending the application period twice to secure eligible candidates for the role, the two candidates who were shortlisted and invited to interview did not meet the criteria for the role; • Both the GB Consultant and Nurse roles have nationally set restrictions on eligibility that has limited the pool of potential candidates – we cannot appoint anyone who works for a provider with which we hold a contract. This rules out the majority of clinicians working in London; • Due to these difficulties, we recommend that the limit on the number of terms that the Governing Body Secondary Care Consultant and Nurse can serve is removed. The current limit is two terms of two years each and an option of a one year extension – a total of five years; • Each extension or new term would still require Members Forum agreement, in line with the existing Constitution and no other detail would change – each term would remain as two years; • Siobhan Clarke has served two terms of two years each, plus a one year extension. If the Members Forum agrees to change our Constitution to remove term limits for these two roles, we also recommend that Siobhan Clarke is approved to start a new two year term from 1 April 2018; • RECOMMENDATION: The Members Forum is asked to agree that the term limit for the GB Consultant and Nurse roles is removed from the Constitution and these GB Members allowed to serve consecutive two terms, each approved by the Members Forum. • RECOMMENDATION: The Members Forum is asked to agree that, if term limits for the GB Consultant and Nurse roles are removed, that Siobhan Clarke is appointed to serve a new two term from 1 April 2018.
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City and Hackney Clinical Commissioning Forum & Members’ Forum Thursday 10 th January 2018 St Joseph’s Hospice
City & Hackney CCG Proposed changes to the Clinical Commissioning and Engagement contract 2018/19
Proposed changes to the CCE Contract 18/19 Green: New Blue: Amended Domain Element 3. Education Engagement with CCE contract accredited education events Adherence to pathways 9 New: Engagement with CCG accredited MECC education Red: Removed Proposed change Current: practices with list size >5, 500; 15 CCG accredited education sessions Increase webinar allowance from 6 to 8 Current: practices with list size <5, 500; 12 CCG accredited education sessions Increase webinar allowance from 3 to 6 New: have champions for (some) existing pathways and/or have inpractice pathways refreshes if needed i. e. need identified through peer to peer reviews Drop reference to DXS New: attend a Making Every Contact Count Education session (could be e-learning) to support integrated commissioning ambitions to achieve a system shift towards prevention
Proposed changes to the CCE Contract 18/19 Domain Element Proposed change Using consultant advice services 5. Routinely In-house review locums of junior GP and juniors locum nonreferrals and urgent referrals activity 4. Consultant services 7. Practice Nurses attendance at targeted PN Education Sessions 1 0 Reference “Advice and Guidance”; establish how searchable this is ref continued need for practices to keeping coding use of consultant advice service Current: the practice will have a system to ensure all non-urgent OPD referrals being proposed by a locum are reviewed by another GP to ensure these are in line with agreed pathways and enhance clinical care before a referral is made Add: practice to make a judgement call on which locums this applies to Drop domain
Proposed changes to the CCE Contract 18/19 Domain 8. Information Sharing & Governance Element Information Sharing & Governance Data Sharing 1 1 Proposed change Drop: supported by the CCG’s Duty Doctor Contract with the Confederation, the practice will have a robust system in place across administrative and clinical teams to ensure when a consultant telephones the practice to discuss a patient with a GP this happens without undue delay Drop: the practice will ensure it completes all fax-backs from the Homerton and other 2 ry care providers (gradually being replaced by the HIE system) in relation to patients acutely attending A&E and return these within 3 hours of receipt Current: the practice will also fax (or send electronically when possible) care plans if asked (details, when available, to be provided by Nikhil Katiyar - n. [email protected] net) – replace with the practice will endeavour to share care plans when asked New: the practice will complete a self-assessment against the General Data Protection Regulations (template provided) and meet with CSU to review as part of a scheduled business continuity meeting New: attend an NHS Digital SNOMED webinar and cascade When necessary, the practice will be asked to sign up to data sharing agreements (within primary care, at the primary/secondary care interface and newly with social care) that demonstrate that it is working with other organisations to facilitate integrated health (add: “and social if agreed” ) care Drop: extend EMIS to EMIS connectivity agreements to include HUH Drop: GPs are encouraged when reporting incidents/significant events arising in primary care to NHS England to tick the box for sharing the incident with their CCG so we can record the types of SIs occurring in City and Hackney and any learning can be shared. The CCG lead for this is Jenny Singleton (jenny. [email protected] net) New: practices will engage with an Integrated Commissioning/CCG/CEG data driven project to prevent admissions e. g. proactive care/Discovery and will engage with future
Proposed changes to the CCE Contract 18/19 Domain Element Proposed change 10. Clinical Commissioning Forum Meetings (CCF) 12. Undertake CQUIN feedback 13. Review of high users of services Show more evidence of cascading (how? ) Drop domain 14. Biannual Review of referrals 16. Medicines Management and 1 Prescribing Incentive 2 Frequent attenders at A&E – amended to high users of unplanned secondary care Sharing learning from quadrant multidisciplinary meetings 16 a. Entry Level criteria for the Prescribing Incentive Each consortium will have a discussion at least once a year (amend to twice a year) about patients who are ‘high attenders at A/E’ (amend to high users of unplanned secondary care) and each practice will be responsible for bringing cases to this meeting. Add: Consortium lead to invite a representative from secondary care to attend this discussion The focus of this is now on neighbourhoods “…areas which have increased significantly or where the practice referral behaviours are either well above or below the average across Hackney are reviewed with colleagues (add: including colleagues outside of the practice such as a buddy practice) in more detail” 16 a no change 16 b-e will be updated by MM team
Proposed changes to the CCE Contract 18/19 Domain Element Proposed change 17. Pan C&H audit – amend to Pan C&H review 18. Public and Patient Involvement (PPI) Focus of review will include colorectal cancer Still only one review required 18 a: Newsletter for patients If newsletter continues no change If newsletter for patients ceases replace with practice to put on practice website/noticeboard various patient facing comms as and when the need arises 18 c: Improving patient feedback 20. Ethnicity DROP: In the 16/17 CCE contract practices were asked to work with their PPGs to collect additional patient satisfaction data using recognised metrics (compatible with the GP Patient Survey and the Friends and Family Test). In 2017/18 the CCG would like practices to continue doing this but may in-year ask it to be done slightly differently or with increased frequency “Practices to request newly registering patients complete a CCG form to collect and record protected characteristics…” (expand to include more patients? ) New: practices are asked to engage in any new work undertaken by the CCG to help improve the quality of ethnicity coding 21. PPG 1 3 New for 17/18: in 2017/18 the practice will receive a capitated sum to spend on practice improvements as agreed with its PPG and as reflected in its practice improvement plan Continue in 18/19 depending on available budget
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City & Hackney IT Enabler Programme – Health Information Exchange (HIE) • Data sharing using HIE for Direct Care - where are we now? Now: …views these organisations: This organisation: C&H GPs HUH A HUH C SJH ELFT MH Barts A LBH City Hackney GPs ü HUH Acute ü ü ü HUH-Community ü ü St. Joseph’s Hospice ü ü ü ELFT Mental Health ü ü Barts Acute ü ü ü London Borough Hackney ü ü • Homerton shares with LBH Social Care: • How can we extend sharing to social care?
IT Enabler Health and Social Care Record Programme London Borough of Hackney Social Care has the following basis for viewing shared care record information: • To support direct care • To better inform practitioners about an individual’s overall situation • To support the preparation of care packages to the service user’s needs • To enable practitioners direct the service user to the right support team • To support all care providers in the efficient exchange of information, releasing more time for care
IT Enabler Health and Social Care Record Programme Supporting guidelines, policies and legislation: • Health and Social care (Safety and Quality ) Act 2015 - A Bill to make provision about the safety of health and social care services in England; makes provision for the duty to share information • Common law of duty of care or confidence • Caldicott 2 – the important of sharing information can be as important as protecting a person’s confidentiality • Caldicott 3 – reiterates the importance of sharing while ensuring patients and the public are aware of the arrangements • NHS Digital’s “A Guide to Confidentiality in Health and Social Care” Rule 2 “Members of a care team should share confidential information when it is needed for the safe and effective care of an individual” • The integrated care agenda – health and social care professionals working collaboratively as a unit
IT Enabler Health and Social Care Record Programme What is the protocol for using HIE for social care? • Same as all health providers! • Data using HIE can only be viewed for an individual who: • • is registered on the Social Care Mosaic IT system has an NHS number, noting only social care service users have NHS number has a legitimate relationship with the social care staff accessing HIE Must obtain consent from the service user to view data using HIE Usage is monitored including usage by named individual and role HIE only displays data that is stipulated in the data sharing agreement Sensitive data is excluded as stipulated in the data sharing agreement: sexual health, terminations, gender identity disorders, IVF
IT Enabler Health and Social Care Record Programme What GP data can be shared with social care? GP data available on HIE Patient Details – demographics including usual GP Medications Diagnoses Problems Risks Warnings –i. e. allergies and contraindications Procedures – including immunisations Events – referrals, admissions, discharges Examinations Investigations – i. e. diagnostic test results Yes/No Example use cases for social care: • GP details – correct contact for an individual when planning their care • Medications – manage the timings of care and support; help the service user with administration e. g. pill dispensers • Problems and Diagnoses – provide assurance of the patient’s conditions which is an important aspect of developing care packages and assessing indicative budgets • Allergies – support plans take these into consideration e. g. types of meals • Immunisations – help reduce duplication of immunisations and/or requests
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Save The Date Paul & Clare’s Leaving Do FRIDAY 23 RD MARCH 2018 From 7 pm CHATS PALACE 42 -44 Brooksby’s Walk, E 9 6 DF MORE INFO TO FOLLOW